Hindocha Pooja, Lyon Alexander R, Bhaskaran Krishnan, Strongman Helen
Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1A 7HT, UK.
National Heart and Lung Institute, Imperial College London and Cardio-Oncology Centre of Excellence, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
Eur Heart J Open. 2025 Apr 25;5(3):oeaf039. doi: 10.1093/ehjopen/oeaf039. eCollection 2025 May.
Evidence for the use of beta-blockers, angiotensin II receptor blockers (ARB), or angiotensin-converting enzyme inhibitors (ACEi) to mitigate chemotherapy-induced cardiotoxicity is inconclusive. The objectives are to investigate associations between prescription of ARBs, ACEis, and/or beta-blockers in the year following cancer diagnosis and subsequent risk of heart failure/cardiomyopathy (HF/CM) in chemotherapy-treated breast cancer and non-Hodgkin lymphoma (NHL) survivors.
This cohort study used linked English electronic healthcare records from 9875 adult (≥18 years) breast cancer and NHL survivors who received chemotherapy. Cox regression was used to estimate the association between primary care-prescribed beta-blocker, ARB, and ACEi use in the year following cancer diagnosis, and subsequent HF/CM incidence, adjusting for potential confounders. Likelihood ratio tests were used to assess effect modification. The mean follow-up duration was 4.9 years (maximum 21.4). After adjusting for age, the risk of HF/CM was higher in the exposed group [hazard ratio (HR): 1.69, 95% confidence interval (CI): 1.34-2.14], but further adjustment for gender, comorbidities, and other medications reduced the association to close to null (HR: 1.07, 95% CI: 0.68-1.69). There was no evidence that the association differed by cancer site, age, radiotherapy, prior cardiovascular disease, or years since cancer diagnosis.
We found no evidence that general practitioner prescribed beta-blocker, ARB, or ACEi use was associated with a reduced incidence of HF/CM in this population of chemotherapy-treated breast cancer and NHL survivors. This might be because the drug dosage and timing were not optimized to prevent chemotherapy-related cardiac damage; residual confounding by indication may also have obscured any treatment benefit.
使用β受体阻滞剂、血管紧张素II受体阻滞剂（ARB）或血管紧张素转换酶抑制剂（ACEi）减轻化疗引起的心脏毒性的证据尚无定论。目的是研究癌症诊断后一年内ARB、ACEi和/或β受体阻滞剂的处方与化疗治疗的乳腺癌和非霍奇金淋巴瘤（NHL）幸存者随后发生心力衰竭/心肌病（HF/CM）风险之间的关联。
这项队列研究使用了来自9875名接受化疗的成年（≥18岁）乳腺癌和NHL幸存者的关联英语电子医疗记录。采用Cox回归估计癌症诊断后一年内初级保健处方的β受体阻滞剂、ARB和ACEi使用与随后HF/CM发病率之间的关联，并对潜在混杂因素进行调整。似然比检验用于评估效应修正。平均随访时间为4.9年（最长21.4年）。调整年龄后，暴露组HF/CM风险更高[风险比（HR）：1.69，95%置信区间（CI）：1.34-2.14]，但进一步调整性别、合并症和其他药物后，该关联降至接近无效（HR：1.07，95%CI：0.68-1.69）。没有证据表明该关联因癌症部位、年龄、放疗、既往心血管疾病或癌症诊断后的年限而异。
我们没有发现证据表明在接受化疗的乳腺癌和NHL幸存者人群中，全科医生开具的β受体阻滞剂、ARB或ACEi的使用与HF/CM发病率降低有关。这可能是因为药物剂量和时机未优化以预防化疗相关的心脏损伤；指征残留混杂也可能掩盖了任何治疗益处。
